CH. 10: FLUID AND ELECTROLYTES

A client has questioned the nurse's administration of intravenous (IV) normal saline, asking, "Wouldn't sterile water be a more appropriate choice than saltwater?" Under what circumstances would the nurse administer electrolyte-free water intravenously? A. Never, because it rapidly enters red blood cells, causing them to rupture. B. When the client is severely dehydrated, resulting in neurologic signs and symptoms C. When the client is in excess of calcium and/or magnesium ions D. When a client's fluid volume deficit is due to acute or chronic kidney disease

A

A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 24 mm Hg. Which condition does the ABG reflect? A. Respiratory acidosis B. Metabolic alkalosis C. Respiratory alkalosis D. Metabolic acidosis

A

The nurse is caring for a client admitted with a diagnosis of acute kidney injury. When reviewing the client's most recent laboratory reports, the nurse notes that the client's magnesium levels are high. The nurse should prioritize assessment for what health problem? A. Diminished deep tendon reflexes B. Tachycardia C. Cool, clammy skin D. Acute flank pain

A

The nurse is caring for a client who has been involved in a motor vehicle accident. The client's labs indicate a minimally elevated serum creatinine level. The nurse should further assess which body system for signs of injury? A. Renal B. Cardiac C. Pulmonary D. Nervous

A

The nurse is caring for a client who is to receive IV daunorubicin, a chemotherapeutic agent. The nurse starts the infusion and checks the insertion site as per protocol. During the most recent check, the nurse observes that the IV has infiltrated so the nurse stops the infusion. What is the nurse's priority concern with this infiltration? A. Extravasation of the medication B. Discomfort to the client C. Blanching at the site D. Hypersensitivity reaction to the medication

A

The nurse is evaluating a newly admitted client's laboratory results, which include several values that are outside of reference ranges. Which of the following alterations would cause the release of antidiuretic hormone (ADH)? A. Increased serum sodium B. Decreased serum potassium C. Decreased hemoglobin D. Increased platelets

A

The nurse is providing care for a client with chronic obstructive pulmonary disease. When describing the process of respiration, the nurse explains to a newly licensed nurse how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing which process? A. Diffusion B. Osmosis C. Active transport D. Filtration

A

The nurse is providing discharge education to a client who had hypophosphatemia while in the hospital. The client has a diet prescribed that is high in phosphate. Which foods should the nurse teach this client to include in the diet? Select all that apply. A. Milk B. Beef C. Potatoes D. Green vegetables E. Liver

A, B, E

A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. Which factors contribute to this phenomenon? Select all that apply. A. Decreased kidney mass B. Increased conservation of sodium C. Increased total body water D. Decreased renal blood flow E. Decreased excretion of potassium

A, D, E

A client with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the client is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid-base imbalance? A. Respiratory acidosis B. Respiratory alkalosis C. Increased PaCO2 D. Metabolic acidosis

B

A medical nurse educator is reviewing a client's recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis? A. The kidneys retain hydrogen ions and excrete bicarbonate ions to help restore balance. B. The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. C. The kidneys react rapidly to compensate for imbalances in the body. D. The kidneys regulate the bicarbonate level in the intracellular fluid.

B

A nurse in the neurologic ICU has received a prescription to infuse a hypertonic solution into a client with increased intracranial pressure. This solution will increase the number of dissolved particles in the client's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described with which of the following terms? A. Hydrostatic pressure B. Osmosis and osmolality C. Diffusion D. Active transport

B

The community health nurse is performing a home visit to an 80-year-old client recovering from hip surgery. The nurse notes that the client seems uncharacteristically confused at times and has dry mucous membranes. When asked about fluid intake, the client states, "I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom." What would be the nurse's best response? A. "I will need to have your medications adjusted, so you will need to be readmitted to the hospital for a complete workup." B. "Limiting your fluids can create imbalances that can result in confusion, so let's try adjusting the timing of your fluids." C. "It is normal to be a little confused following surgery, and it is safe not to urinate at night." D. "Confusion and bladder issues are a normal consequence of aging, so I am not too concerned."

B

The nurse caring for a client post colon resection is assessing the client on the second postoperative day. The nasogastric tube remains patent and is draining moderate amounts of greenish fluid. Which assessment finding would suggest that the client's potassium level is too low? A. Diarrhea B. Paresthesias C. Increased muscle tone D. Joint pain

B

The nurse is caring for a client with a diagnosis of pancreatitis. The client was admitted from a homeless shelter and is a vague historian. The client appears malnourished and on day 3 of the client's admission, total parenteral nutrition (TPN) has been started. Why should the nurse start the infusion of TPN slowly? A. Clients receiving TPN are at risk for hypercalcemia if calories are started too rapidly. B. Malnourished clients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively. C. Malnourished clients who receive fluids too rapidly are at risk for hypernatremia. D. Clients receiving TPN need a slow initiation of treatment in order to allow digestive enzymes to accumulate.

B

The surgical nurse is caring for a client who is postoperative day 1 following a thyroidectomy. The client reports tingling in the lips and fingers. The client also reports an intermittent spasm in the wrist and hand and exhibits increased muscle tone. Which electrolyte imbalance should the nurse first suspect? A. Hypophosphatemia B. Hypocalcemia C. Hypermagnesemia D. Hyperkalemia

B

A client with hypokalemia is to receive intravenous (IV) potassium replacement. Which action should the nurse take when administering potassium intravenously? Select all that apply. A. Administer potassium by IV push. B. Assess blood urea nitrogen (BUN) and serum creatinine prior to potassium administration. C. Monitor complete blood count during potassium infusion. D. Follow the facility policy for infusion of potassium. E. Report a reduced urinary output to the health care provider.

B, D, E

A client with hypertension has been prescribed hydrochlorothiazide. What nursing action will best reduce the client's risk for electrolyte disturbances? A. Maintain a low-sodium diet. B. Encourage the use of over-the-counter calcium supplements. C. Ensure the client has sufficient potassium intake. D. Encourage fluid intake.

C

A nurse, who is orienting a newly licensed nurse, is planning care for a nephrology client. The nurse states, "A client with kidney disease partially loses the ability to regulate changes in pH." What is the cause of this partial inability? A. The kidneys regulate and reabsorb carbonic acid to change and maintain pH. B. The kidneys buffer acids through electrolyte changes. C. The kidneys reabsorb and regenerate bicarbonate to maintain a stable pH. D. The kidneys combine carbonic acid and bicarbonate to maintain a stable pH.

C

One day after a client is admitted to the medical unit, the nurse determines that the client is oliguric. The nurse notifies the acute-care nurse practitioner who prescribes a fluid challenge of 200 mL of normal saline solution over 15 minutes. This intervention will help to achieve what goal? A. Distinguish hyponatremia from hypernatremia. B. Evaluate pituitary gland function. C. Distinguish reduced renal blood flow from decreased renal function. D. Provide an effective treatment for hypertension-induced oliguria.

C

The nurse in the medical intensive care unit is caring for a client who is in respiratory acidosis due to inadequate ventilation. Which diagnosis could the client have that could cause inadequate ventilation? A. Endocarditis B. Multiple myeloma C. Guillain-Barré syndrome D. Overdose of amphetamines

C

The nurse is assessing the client for the presence of a Chvostek sign. Which electrolyte imbalance would a positive Chvostek sign indicate? A. Hypermagnesemia B. Hyponatremia C. Hypocalcemia D. Hyperkalemia

C

The nurse is called to a client's room by a family member who voices concern about the client's status. On assessment, the nurse finds the client tachypneic, lethargic, weak, and exhibiting a diminished cognitive ability. The nurse also identifies 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this client's signs and symptoms? A. Hypocalcemia B. Hyponatremia C. Hyperchloremia D. Hypophosphatemia

C

The nurse is caring for a client admitted to the medical unit 72 hours ago with pyloric stenosis. A nasogastric tube was placed upon admission, and since that time the client has been on low intermittent suction. Upon review of the morning's blood work, the nurse notices that the client's potassium is below reference range. The nurse should assess for signs and symptoms of what imbalance? A. Hypercalcemia B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory acidosis

C

The nurse is caring for a client who has a peripheral IV in place for fluid replacement. When caring for the client's IV site, the nurse should: A. ensure that anticoagulants are placed on hold for the duration of IV therapy. B. replace the IV dressing with a new, clean dressing if it is soiled. C. ensure that the tubing is firmly anchored to the client's skin. D. periodically remove hair from 2 cm around the IV site.

C

The nurse is performing an admission assessment on a 79-year-old client newly admitted for end-stage liver disease. What principle should guide the nurse's assessment of the client's skin turgor? A. Overhydration is common among healthy older adults. B. Dehydration causes the skin to appear spongy. C. Inelastic skin turgor is a normal part of aging. D. Skin turgor cannot be assessed in clients over the age of 70.

C

While assessing a client's peripheral IV site, the nurse observes edema and coolness around the insertion site. How should the nurse document this observation? A. Air embolism B. Phlebitis C. Infiltration D. Fluid overload

C

A client comes into the emergency department (ED) by ambulance with a hip fracture after slipping and falling while at home. The client is alert and oriented but anxious and reports thirst. The client's pupils are equal and reactive to light and accommodation, and the heart rate is elevated. An indwelling urinary catheter is inserted, and 40 mL of urine is present. What is the nurse's most likely explanation for the client's urinary output? A. The client urinated prior to arrival to the ED and will probably not need to have the urinary catheter kept in place. B. The client likely has a traumatic brain injury, lacks antidiuretic hormone, and needs vasopressin. C. The client is experiencing symptoms of heart failure and is releasing atrial natriuretic peptide, which results in decreased urine output. D. The client is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system, which results in diminished urine output.

D

A client's most recent laboratory results show a slight decrease in potassium. The health care provider has opted to forgo drug therapy but has suggested increasing the client's dietary intake of potassium. What should the nurse recommend? A. Apples B. Fish C. Rice D. Bananas

D

Baroreceptors in the left atrium and in the carotid and aortic arches respond to changes in the circulating blood volume and regulate sympathetic and parasympathetic neural activity as well as endocrine activities. Sympathetic stimulation constricts renal arterioles, causing what effect? A. Decrease in the release of aldosterone B. Increase of filtration in the Loop of Henle C. Decrease in the reabsorption of sodium D. Decrease in glomerular filtration

D

Diagnostic testing has been prescribed to differentiate between normal anion gap acidosis and high anion gap acidosis in an acutely ill client. What health problem often precedes normal anion gap acidosis? A. Metastases B. Excessive potassium intake C. Water intoxication D. Excessive administration of chloride

D

The emergency-room nurse is caring for a trauma client who has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How should the nurse interpret these results? A. Respiratory acidosis with no compensation B. Metabolic alkalosis with compensatory alkalosis C. Metabolic acidosis with no compensation D. Metabolic acidosis with compensatory respiratory alkalosis

D

The intensive care unit nurse is caring for a client who experienced trauma in a workplace accident. The client is reporting dyspnea because of abdominal pain. An arterial blood gas test reveals the following results: pH 7.28, PaCO2 50 mm Hg, HCO3- 20 mEq/L. The nurse should recognize the likelihood of which acid-base disorder(s)? A. Respiratory acidosis only B. Respiratory acidosis and metabolic alkalosis C. Respiratory alkalosis and metabolic acidosis D. Respiratory acidosis and metabolic acidosis

D

The nurse is caring for a client who has a diagnosis of syndrome of inappropriate antidiuretic hormone secretion. The plan of care includes assessment of specific gravity every four hours. The results of this test will allow the nurse to assess which aspect of the client's health? A. Nutritional status B. Potassium balance C. Calcium balance D. Fluid volume status

D

The nurse is caring for a client who is being treated on the oncology unit with a diagnosis of lung cancer with bone metastases. The client reports a new onset of weakness with abdominal pain, and further assessment suggests that the client likely has a fluid volume deficit. The nurse should recognize that this client may be experiencing which electrolyte imbalance? A. Hypernatremia B. Hypomagnesemia C. Hypophosphatemia D. Hypercalcemia

D

The nurse is caring for a client with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis? A. Hypertension B. Kussmaul respirations C. Increased DTRs D. Shallow respirations

D

The nurse is working on a burn unit and an acutely ill client is exhibiting signs and symptoms of third spacing. Based on this change in status, the nurse should expect the client to exhibit signs and symptoms of which imbalance? A. Metabolic alkalosis B. Hypermagnesemia C. Hypercalcemia D. Hypovolemia

D

When planning the care of a client with a fluid imbalance, the nurse understands that in the human body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur? A. Active transport of hydrogen ions across the capillary walls B. Pressure of the blood in the renal capillaries C. Action of the dissolved particles contained in a unit of blood D. Hydrostatic pressure resulting from the pumping action of the heart

D